Next Big Thing? Cholesterol Drop With New Drug

CHICAGO – An experimental Merck drug safely boosted good cholesterol to record highs while dropping bad cholesterol to unprecedented lows in a study that stunned researchers and renewed hopes for an entirely new way of lowering heart risks.

"We are the most excited we have been in decades" about a novel drug, said the study's leader, Dr. Christopher Cannon, of Brigham and Women's Hospital in Boston. "This could really be the next big thing."

The drug, anacetrapib (an-uh-SEHT'-ruh-pihb), won't be on the market anytime soon. It needs more testing to see if its dramatic effects on cholesterol will translate into fewer heart attacks, strokes and deaths. Merck & Co. announced a 30,000-patient study to answer that question and it will take several years.

But the sheer magnitude of its effects so far caused big excitement at an American Heart Association conference in Chicago, where results were presented on Wednesday.

"The data look spectacular, beyond what anybody would have expected," said Dr. Robert Eckel, a University of Colorado cardiologist and past president of the heart association. "It's like a rocket to Jupiter versus one to the moon. I can think of many of my patients who could use the drug right now."

Merck's Dr. Luciano Rossetti agreed.

"We are trying not to be too giddy. The potential benefit is enormous," said Rossetti, senior vice president of global scientific strategy at the company, based in Whitehouse Station, N.J.

For years, doctors have focused on lowering LDL, or bad cholesterol, to cut heart risks. Statin medicines, sold as Lipitor, Zocor and in generic form, do this. But many statin users still suffer heart attacks, so doctors have been trying to get LDL to very low levels and to boost HDL, or good cholesterol.

Anacetrapib would be the first drug of its kind. It helps keep fat particles attached to HDL, which carries it in the bloodstream to the liver to be disposed of.

The Merck-sponsored study tested it in 1,623 people already taking statins because they are at higher than usual risk of a heart attack — half had already had one, and many others had conditions like diabetes. An LDL of 100 to 129 is considered good for healthy people, but patients like these should aim for under 100 or even under 70, guidelines say. For HDL, 40 to 59 is OK, but higher is better.

After six months in the study:

_LDL scores fell from 81 to 45 in those on anacetrapib, and from 82 to 77 in those given dummy pills.

_HDL rose from 41 to a whopping 101 in the drug group, and from 40 to 46 in those on dummy pills.

Such large changes have never been seen before, doctors say, and these improvements persisted for at least another year that the study went on.

The study was too small to tell whether anacetrapib lowered deaths, heart attacks or other heart problems, but the trend was in the right direction, with fewer of those cases among patients on the drug. The anacetrapib group also needed significantly fewer procedures to fix clogged arteries.

Importantly, there were no signs of the blood pressure problems that led Pfizer Inc. to walk away from an $800 million investment in torcetrapib, a similar drug it was developing four years ago.

"This one looks far more potent, without the serious side effects that led to failure," Dr. W. Douglas Weaver, a cardiologist at Henry Ford Health System in Detroit and past president of the American College of Cardiology, said of the new Merck drug. "If proven effective, this will really change practice in the same way aspirin and statins have."

Results of the study also were published online by the New England Journal of Medicine. Some study leaders have consulted for Merck and makers of other heart drugs.

The only other drug that has had major effects on bad and good cholesterol — albeit much smaller than those from anacetrapib — is niacin, a type of B vitamin sold in an extended-release version as Niaspan by Kos Pharmaceuticals Inc. It has been on the market since the late 1990s, but some people are bothered by a prickly-hot sensation called flushing. Doctors say this side effect can be minimized by taking the drug at night with a low-fat snack.

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